Regan Susan, Howard Sydney, Powell Elizabeth, Martin Alister, Dutta Sayon, Hayes Bryan D, White Benjamin A, Williamson Dawn, Kehoe Laura, Raja Ali S, Wakeman Sarah E
Department of Medicine, Massachusetts General Hospital, Boston, MA (SR, SH, LK, SEW); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (EP); Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (AM, SD, BAW, ASR); Department of Pharmacy, Massachusetts General Hospital, Boston, MA (BDH); Department of Nursing, Massachusetts General Hospital, Boston, MA (DW).
J Addict Med. 2022;16(2):216-222. doi: 10.1097/ADM.0000000000000875.
Emergency department (ED) initiated opioid use disorder (OUD) care is effective; however, real-world predictors of patient engagement are lacking.
This program evaluation examined predictors of ED-based OUD treatment and subsequent engagement.
Program evaluation in Boston, MA. Adult patients who met criteria for OUD during an ED visit in 2019 were included. Patients were included if a diagnosis of OUD or opioid-related overdose was associated with the ED visit or if they met previously validated criteria for OUD within the previous 12 months. We assessed predictors of ED-OUD treatment receipt and subsequent engagement, using Healthcare Effectiveness Data and Information Set definition of initial encounter within 14 days of discharge and either 2 subsequent encounters or a subsequent buprenorphine prescription within 34 days of the initial encounter. We used generalized estimating equations for panel data.
During 2019, 1946 patients met criteria for OUD. Referrals to Bridge Clinic were made for 207 (11%), buprenorphine initiated for 106 (5%), and home induction buprenorphine kits given to 56 (3%). Following ED discharge, 237 patients (12%) had a visit within 14 days, 122 (6%) had ≥2 additional visits, and 207 (11%) received a subsequent buprenorphine prescription. Young, White, male patients were most likely to receive ED-OUD care. Patients who received ED-OUD care were more likely to have subsequent treatment engagement (adjusted rate ratio: 2.30, 95% confidence intervals: 1.62-3.27). Referrals were made less often than predicted for Black (-49%) or Hispanic/Latinx (-25%) patients.
Initiating treatment for OUD in the ED was associated with increased engagement in outpatient addiction care.
急诊科启动的阿片类药物使用障碍（OUD）护理是有效的；然而，缺乏患者参与度的现实预测因素。
本项目评估研究了基于急诊科的OUD治疗及后续参与度的预测因素。
在马萨诸塞州波士顿进行项目评估。纳入2019年在急诊科就诊期间符合OUD标准的成年患者。如果OUD诊断或阿片类药物相关过量与急诊科就诊相关，或者他们在过去12个月内符合先前验证的OUD标准，则纳入患者。我们使用医疗保健有效性数据和信息集对出院后14天内的首次就诊以及随后的2次就诊或首次就诊后34天内的后续丁丙诺啡处方的定义，评估了接受急诊科OUD治疗及后续参与度的预测因素。我们对面板数据使用广义估计方程。
2019年期间，1946名患者符合OUD标准。207名（11%）患者被转诊至桥梁诊所，106名（5%）患者开始使用丁丙诺啡，56名（3%）患者获得家庭诱导丁丙诺啡试剂盒。急诊科出院后，237名患者（12%）在14天内就诊，122名（6%）患者有≥2次额外就诊，207名（11%）患者获得后续丁丙诺啡处方。年轻、白人、男性患者最有可能接受急诊科OUD护理。接受急诊科OUD护理的患者更有可能在后续接受治疗（调整后的率比：2.30，95%置信区间：1.62 - 3.27）。黑人（-49%）或西班牙裔/拉丁裔（-25%）患者的转诊次数低于预期。
在急诊科启动OUD治疗与门诊成瘾护理参与度增加相关。
